The 2018 Tri-Service Emergency Medicine Conference was held at Redford Cavalry Barracks, Edinburgh from 21-22 November 2018. Abstracts were invited from military trainees in emergency medicine, and subjected to standardised assessment and scoring. The authors of the highest scoring abstracts were
Limb fractures are common in pre-hospital care and can be associated with significant haemorrhage and neurovascular compromise. The pre-hospital management of these injuries centres around reduction and splinting. The aim of this study was to quantify the effectiveness of pre-hospital reduction of displaced fractures or dislocations and the incidence of the need for further manipulation in the emergency department. A three-year retrospective database analysis was conducted for all patients sustaining limb injuries who were attended by a single air ambulance and subsequently conveyed to the regional major trauma centre. Only patients who received ketamine, either as an analgesic or sedative, were included. Pre-hospital clinical records and emergency department (ED) notes were examined to determine outcomes. Over the study period, 122 patients sustained a limb injury and received ketamine; ED notes were available for 96 (78.7%). Of these, the majority (n=51, 41.8%) received ketamine for analgesia with n=10 (8.2%) receiving it to facilitate manipulation. The principal indication for pre-hospital manipulation was neurovascular compromise (n=7, 70.0%). Of those undergoing manipulation pre-hospital, the majority (n=7, 70.0%) required further manipulation in the ED. Pre-hospital manipulation by our regional air ambulance is a relatively low frequency event and in those undergoing a manipulation, a high proportion require further intervention in the ED or operative intervention within the acute phase of care.
The final part of my indoctrination into the Pusser medical services was a one-week course in venereal diseases at the Royal Naval Barracks. The old Surgeon Captain who was teaching us gave one final piece of advice: "In your naval practice you will see some STDs that you cannot diagnose and are
As a naval hero Vice-Admiral Lord Horatio Nelson holds a special place in the affections of the British people. Any expectation that his country would provide for Lady Emma Hamilton and his daughter, Horatia, was almost forgotten when he died. However, following Emma’s death, Nelson’s family shaped Horatia’s destiny, which resulted in a happy marriage and a large family. Her second son, Marmaduke, was influenced by an uncle, a surgeon, who trained and guided him towards a surgical qualification and a life at sea as a surgeon in the Royal Navy. Despite a paucity of documentary evidence, it has been possible to trace his progress by analysing his Admiralty service record and abstracting information from an extensive biography of his mother. As another piece in the Nelson narrative, this account adds a medical perspective.
When Haslar Hospital admitted its first patients in 1753 ([Figure 1][1]), there was no book of instructions for the Naval Hospitals. There was, however, a collection of forms for use in any naval medical establishment: By the Commissioners for taking care of sick and wounded seamen, and for
Abstract In March 2018, a team of five UK Defence Medical Service (DMS) personnel deployed to Hawaii in order to take part in the US Navy-led PACIFIC PARTNERSHIP (PP18) mission. This was the third deployment of UK DMS personnel to this annual humanitarian and disaster relief preparedness mission and further supported a shift in focus into the Indo-Asia-Pacific Region.
WESTLANT 18 saw a Role 2 Afloat (R2A) team deploy on HMS QUEEN ELIZABETH (QNLZ) to support the First of Class Flying Trials for the F-35 Lightning 2 aircraft. This team established the R2A capability onboard QNLZ and began the process of developing R2A support to Carrier Strike Group (CSG) operations. The deployment was a great success and many lessons were identified. The experience from this deployment is summarised and the current R2A support to CSG is described.
The maiden deployment of HMS QUEEN ELIZABETH (WESTLANT 18) was supported by a Role 2 Afloat (R2A) team. This deployment enabled the first of class fixed wing flying trials for the F35-B Lightning and gave the deployed team the opportunity to establish the R2A capability within the Carrier Strike Group. During the deployment the team engaged in continuous medical education and training. This paper describes the experience of the team utilising in-situ simulation techniques, which had not been used before on a R2A deployment. In particular, a high fidelity in-situ simulation exercise (Ex POSEIDON) was enabled with the support of the US Navy, and the lessons identified from this are described.
Abstract The daily energy requirements for specialist military troops can reach 5000 kcal during training and wartime deployment. Maintaining energy balance is important for health and physical and mental performance in this population, who can effectively be considered as high-performance endurance athletes. In the sporting world, a balanced diet consisting of 50-60% carbohydrate (CHO), 20-25% protein and 25-30% fat is recommended for these athletes. CHO intake is regarded as a key dietary constituent, as this substrate provides the sole fuel source during high-intensity exercise. However, achieving such high CHO intake rates can be challenging for military personnel, especially in the field. In sports nutrition, athletes commonly use dietary CHO supplements to reduce this deficit. There may be lessons and insight from nutrition and metabolism in sport that could provide Royal Marines, Medical Officers and other embedded medical professionals with strategies to increase CHO intake during intense training or combat situations. This review will highlight the exercise demands of infantry soldiering, will suggest supplementary strategies to increase CHO intake, in addition to dietary intake, and will describe the metabolic effects of CHO ingestion during prolonged activity in the context of military exercise.
In his preface the author makes it clear that this book is a successor to his Poxed and scurvied: the story of sickness & health at sea (Barnsley: Seaforth, 2011). It covers the Royal Naval Medical Service's service during 1939-1945 in more detail than the scope of the earlier book allowed, and
AbstractAimsLateral ankle ligament instability is a common and often debilitating condition affecting service personnel. This study aimed to assess the outcome of surgical repair utilising a modified Broström-Gould technique for patients in whom conservative therapies had failed.MethodsMilitary patients who underwent ankle surgery at Frimley Park Hospital between 2011-2016 were identified. Patients were contacted and asked to complete a retrospective Visual Analogue Score and Manchester Oxford Foot Questionnaire (MOxFQ). DMICP data were reviewed to identify return to fitness.Results109 military patients underwent surgery during this period, of whom 46 were contactable and completed the questionnaires. The median satisfaction score was 9/10, with 89% acknowledging that they would have the same procedure again. The mean increase in stability was 3 to 8 (out of 10), p<0.005. 66% of respondents were still serving in the armed forces, but poor residual ankle function contributed to 23% leaving the military. Of those remaining in service, 50% had returned to a medically fully deployable status at an average of 9.9 months from the date of surgery.ConclusionsThis study has defined outcomes from ankle ligament repair that should help clinicians to manage the expectations of patients referred for this type of surgery.
When studies measure the effect of a treatment longitudinally over time, multiple data points are generated, but are sometimes incomplete. This may affect studies in a range of different settings, including studies on military patients. When analysing the data from such a study, one of the challenges is how to deal with missing data points in the final analysis. This article describes the possible different ways of dealing with missing data points in such a context, and outlines some pragmatic methods used for handling missing pain scores in the recent PAin SoluTions In the Emergency Setting (PASTIES) trials.
Sir, Extremity injuries have accounted for up to 75% of all injuries during military conflicts over the last 100 years and, more recently, almost half of the injuries sustained by service personnel on OP HERRICK.[1][1] Explosions were the leading mechanism of injury, with road traffic accidents as
Admiral Revell was a consultant anaesthetist in the Royal Navy (RN) and his career culminated in becoming the Surgeon General before retiring in 1997. As an orthopaedic surgeon in the RN until 2000, I was lucky enough to work with him as our paths crossed and he became a mentor and friend to myself
Dear Sir, I would like to make your readers aware of the Tri-Service Trainee Audit and Research (Tri-STAR) network. In 2013, the Research and Audit Federation of Trainees (RAFT) was formed to encourage collaboration between the burgeoning number of anaesthetic trainee research networks (TRNs) that
On 23 June 1969 I strolled gingerly up the drive of the then Royal Naval Medical School (RNMS) Alverstoke, in awe of the surroundings, to start my new job as a typist. Compared to Portsmouth Dockyard, where I had worked for 8 years, it was as though I was entering a private estate. I had lived in
Maintenance of a breathable atmosphere is a core tenet of dived submarine operations, and the responsibility for this falls to the medical department. Nitrogen oxides (NOx) are atmospheric contaminants from a currently unconfirmed source. If not controlled, these contaminants can act as respiratory irritants and asphyxiants which may endanger health and threaten sustained dived operations. Using the issued Dräger Short Term Detection Tubes (STDTs) to sample strategic locations, the relationship between atmospheric contaminants and NOx was investigated in an attempt to determine the source of NOx formation. Interventions were implemented to reduce NOx by reducing leakage of monoethanolamine (MEA) from carbon dioxide (CO2) scrubbing equipment, a known potential source of NOx if oxidised (combusted). Dräger STDTs for NH3 demonstrate cross-reactivity with MEA, these levels being referred to as NH3/MEA. A relationship was demonstrated between elevated readings for atmospheric NH3/MEA and elevated readings for NOx, with a variable lag period. Findings suggest that NOx production may be reduced by control of atmospheric NH3/MEA. Of the control measures examined, replacement of resin filter bags was noted to reduce atmospheric NH3/MEA, while replenishment of CO2 scrubber MEA was noted to increase it, with a resultant increase in NOx production. Elevated NH3 atmospheric readings may in fact be due to MEA from CO2 scrubbers. This, when catalytically oxidised by CO/H2 burners, produces NOx. Management of MEA egress from CO2 scrubbers (carryover) represents a potential target for NOx control interventions. Specific MEA detection equipment is required to demonstrate whether MEA or NH3 is the progenitor species for NOx. Furthermore, controlled trials are required to prove a definitive relationship between MEA and NOx and to evaluate the best control measures.
AbstractThe dawn of the 21stcentury has seen a dramatic increase of mass casualty events internationally, with a number of aetiologies. The key with any healthcare evolution is to identify whether lessons learned are being implemented to help to mitigate future events. This article will explore the lessons learned from mass casualty events over the last five years.
The Editorial of Volume 34 (1948), “edited by the staff of the Royal Naval Medical School”, opened with a “word of explanation about the present position of the Journal of the Royal Naval Medical Service … It will be recalled that prior to the outbreak of war the Editors of the Journal were
The increased movement of migrants across the Mediterranean to the European Union intensified in 2015. This paper will focus on the complex experiences and lessons learnt by three Medical Officers (MOs) involved in one year of maritime rescue operations in the Mediterranean (August 2016 to July 2017). During this period a total of 7930 people were rescued by the Royal Navy (RN), with the largest single rescue involving 712 people. The medical teams involved delivered sustained care for periods of up to 80 hours, often with no immediate casualty evacuation available. The scope of clinical practice was wide and challenging, from the birth of infants, to the delivery of care to those with burns, gunshot wounds, sepsis and drowning. The teams were often confronted with mass casualty events, a challenge for any deployed unit.
